Diabetes is a chronic disease that affects over 16 million people in the United States alone - with almost 800,000 new cases diagnosed every year. About 60-70 percent of people with diabetes have some form of diabetic nerve damage called neuropathy. When neuropathy affects the peripheral sensory nerves, as it commonly does, it can cause loss of feeling in the feet. Once some feeling in the feet is lost, the patient is at risk for developing ulcers - pressure sores. Due to the fact that diabetes also contributes to decreased blood circulation in the feet, these ulcers are often slow to heal. If an ulcer gets infected, as it well could since diabetes compromises a body's ability to fight infection, and the infection reaches bone, it could lead to an amputation of a toe, foot or even a leg. Diabetes is the leading cause of non-traumatic amputations year-in and year-out in the U.S. – with 86,000 performed annually, accounting for over half of all lower extremity amputations. The sad, but encouraging truth is that most of these amputations are preventable.

One of the best ways to prevent ulcers and amputations is therapeutic footwear. A board-certified pedorthist is a specialist trained in all aspects of therapeutic footwear. Therapeutic footwear for people with diabetes includes shoes, shoe modifications, socks, protective multi-density inserts, and custom foot orthoses.
Shoes

A pedorthist begins by measuring the feet- BOTH feet, as one foot is commonly larger than the other. The pedorthist then helps the patient select a shoe that is the proper shape for his/her foot. Since sizes vary from manufacturer to manufacturer - and often from style to style - the fit of a shoe is infinitely more important than the number size printed on the shoe box. The pedorthist will check to see that the shoe is wide enough and that the widest part of the foot rests comfortably in the widest part of the shoe. He or she will also check to see that the shoe is the correct length - leaving about a thumb's width between the end of the longest toe and the front of the shoe. The style of shoe will be determined by the patient's activity level and by what the desired effect of the footwear is - typically protection, accommodation, support, control or stability. Often, pedorthists recommend shoes made of leather which allows the foot to "breath" and can be easily stretched. The best shoes for people with diabetes are usually ones with thick, cushioned soles. If the physician has prescribed orthoses, the pedorthist will recommend depth shoes with removable factory insoles that can be replaced with the new devices.
Orthoses

Traditionally, an orthosis is fabricated using a mold of the patient's foot. Orthoses can be made of any number of materials but are normally made of a soft, protective material for people with diabetes. An ulcer can develop in any spot on the foot where there is excessive pressure. A primary function of the orthosis is to reduce pressures at potential problem sites. Once the orthoses have been fitted and rechecked, they will need to be properly maintained, which includes periodic replacement.
 

The Patient’s Responsibility Since many people with diabetes have neuropathy, they cannot always tell if a shoe is fitting properly without some assistance. That is why working with a qualified pedorthist is essential. However, for people who have not lost feeling in their feet, it is very important to tell the pedorthist if the shoes don't feel comfortable at the "try-on" stage. It is never a good idea to buy a shoe, expecting it to stretch as it is worn. Remember that a person's feet may change size over the course of years, so it is important to have the feet measured each time a new pair of shoes is purchased. People with diabetes need to check their feet each and every day. They need to be aware of any changes in their feet. The presence of new blisters, calluses or red spots necessitates a visit to a specialist for help. Checking the feet several times a day is imperative when breaking in a new pair of shoes or orthoses. People with diabetes should never go barefoot.

Consistent follow-up with both a pedorthist and a physician is crucial in preventing foot problems related to diabetes. A person with diabetes needs to make sure that the physician examines his/her feet at every check-up appointment.

The best approach to preventing problems is a team approach -
and the patient is the team leader!